Combating Vaccine Access Inequality in Developing Countries

SEATTLE — Vaccine access inequality is critical to understanding the implementation of one of modern medicine’s most unique tools in fighting disease. Vaccines have incredible power to prevent illness before it arises, but access to this medical advancement is disproportionately correlated to income and a given country’s economic standing.

Many countries around the world have successful medical systems despite past economic instability. For instance, despite being a low-income country (based on GDP per capita), Rwanda has a highly advanced health insurance system that has helped lower maternal mortality rates, reduce tuberculosis deaths and provide free vaccine coverage.

Despite such success stories, vaccine access inequality is a global deterrent to improved health outcomes for marginalized groups. Some vaccines are highly effective and have a high market demand and multiple manufacturers, all factors leading to a relatively low price to be covered by the consumer. However, other vaccines such as the RTS, S/AS01 malaria vaccine can take decades to produce with a substantial investment cost (for RTS, S it is estimated to be around $500 million). Despite this investment, a recent New England Journal of Medicine article proposed that the benefits of this new malaria vaccine are minimal after only four years.

With such economic and technological complexities already existing in the vaccine development industry, it is unlikely that every disease will be preventable by vaccines in the near future. However, for vaccines that are already proven to work, there are still formidable obstacles for certain populations, mostly dependent on income and country of residence.

Despite advances in vaccine development and distribution, there are still an estimated 21.8 million children worldwide that have not received immunizations deemed routine by the World Health Organization. In 2015, in the regions of Africa and southeast Asia, the administration of the vaccine against diphtheria, pertussis and tetanus had only reached 75 percent and 77 percent, respectively, despite the Millennium Development Goal striving for 90 percent coverage. In some countries, such as Afghanistan and Somalia, vaccination rates were below 20 percent.

The reasons for such variations are complex and stem from economic, geographic and social factors. For instance, in 35 of the 86 countries studied, there were significantly higher rates of vaccination in cities than in rural areas. Additionally, 45 of the 86 countries studied showed a correlation between increasing wealth and increasing likelihood of receiving vaccine coverage. Many countries witnessed an increase in wealth inequality during the study period, widening the divide in vaccine access inequality.

The phenomenon of the predictive power of wealth on vaccine coverage is not only relevant in developing countries. In London, a BMC Public Health study revealed vaccination rates of homeless individuals to be 23.7 percent compared to the national average of 53.2 percent. A separate study revealed that socioeconomic status in Ireland was the largest predictor of whether or not children had received routine vaccines.

These trends are a compelling example of the Inverse Care Law, which states that access to medical care is inversely related to the medical need of a given population. More disadvantaged families tend to have more health concerns, but receive less care than those who are of a higher socioeconomic status and thus, on average, healthier. This principle is more exaggerated in healthcare economies that are more market-driven. This would imply that disadvantaged individuals living in highly market-based healthcare economies are at the greatest risk of receiving inadequate care, including vaccines.

The apparent flaw in current models of healthcare is not only that the most vulnerable populations are at higher risk of disease incidence, but that governments and international bodies are not implementing a stronger global vaccine program. The GAVI Alliance and the PATH project of the World Health Organization are two programs attempting to enhance and streamline vaccine delivery systems while ensuring quality control and the capability of meeting diverse local population needs, but the gap between need and access is still profound.

Vaccines not only avert death, disease and disability, but also provide a cost-effective intervention. The Johns Hopkins Bloomberg School of Public Health advocates for enhanced vaccine access for its benefit to well-being, but also for the cost-savings potential. In the long term, improving access to pneumococcal, Hib and rotavirus vaccines would avert 3.7 million deaths in at-risk countries. This would save $1.4 billion in averted healthcare costs that would be used to treat children who would fall ill without the vaccine. The less obvious but crucial aspect of cost savings is in future economic productivity that would be lost if these children were condemned to death and disability. This total is estimated to be $61 billion.

The well-known Article 25 of the Universal Declaration of Human Rights states health as a universal human right. A less cited but crucial value of this declaration was Article 27, which guarantees the right to share in scientific advancement and its benefits. Vaccines are one of the most important scientific advances in healthcare in the 20th and 21st centuries. However, when this technology is deployed within socially stratified market-based healthcare economies, vaccine access inequality harms the people who need such vaccines most. Augmented domestic and international funding for egalitarian vaccine access has the potential to save millions of lives while providing the greatest economic benefit to the most at-risk geographic areas and local communities.